# Mobile Health intervention for rural atrial fibrillation

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2021 · $732,765

## Abstract

Atrial fibrillation (AF) is a highly prevalent, morbid condition. Anticoagulation to prevent thromboembolic strokes
is a foremost priority in AF but adherence is challenging for patients and lapses in anticoagulation are
common. Chronic disease self-management (CDSM) is a recognized program to enhance self-efficacy and
improve adherence, quality of life, and patient-centered health outcomes. Rural patients with AF experience
increased vulnerability to adverse outcomes due to geographic and social isolation, poor health care access,
and limited health literacy. We propose an innovative, scalable CDSM intervention to improve anticoagulation
adherence in rural patients with AF. This single-center parallel group randomized clinical trial employs an
embodied conversational agent (ECA) delivered by smartphone. We have used the ECA – a computer
character that simulates face-to-face conversation using voice, hand gesture and gaze cues to provide
education, monitoring and problem-solving – to improve health behaviors and outcomes in individuals with
limited computer and health literacy. Here, guided by a patient advisory committee, we propose to expand our
successful 30-day ECA pilot to develop a novel CDSM program for AF. We combine the ECA with the AliveCor
Kardia smartphone heart rate and rhythm monitor. We implement a 4-month CDSM curriculum and assess its
sustainability at 8 and 12 months. Our trial randomizes 264 patients with AF who are receiving anticoagulation
for stroke prevention to (1) the ECA/Kardia intervention, accompanied by provider alerts for prespecified
results; or (2) the control, consisting of an AF educational session and a smartphone with a general health
application (WebMD). Our trial leverages the clinical infrastructure of the University of Pittsburgh across
western Pennsylvania by recruiting at 7 rural clinics that share a common electronic health record. Our aims
are: (1) To assess the effect of the ECA/Kardia intervention on anticoagulant adherence, as determined by the
medication possession ratio, electronic pill count, and self-report. (2) To identify the effect of the intervention on
health care utilization accounting for costs of the intervention, hospitalizations, emergency visits, and AF-
related procedures at 1-year follow up. (3) To determine the effect of the intervention on the patient-centered
outcomes of quality of life and symptoms, as measured by the AF Effect on QualiTy of life (AFEQT) measure,
specific to AF, and the general Patient-Reported Outcomes Measurement Information System-29 Profile at
baseline, 4, 8 and 12 months. (4) To examine mechanisms for the effect of the intervention by symptom
burden, AF classification, health literacy and intervention use. We will additionally follow the cohort through the
study period for exploratory analyses of rurality and outcomes associated with AF. Expected Results: In this
project we will evaluate a scalable patient-centered intervention to improve anticoagulation adh...

## Key facts

- **NIH application ID:** 10240320
- **Project number:** 5R01HL143010-03
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Jared W. Magnani
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $732,765
- **Award type:** 5
- **Project period:** 2019-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10240320

## Citation

> US National Institutes of Health, RePORTER application 10240320, Mobile Health intervention for rural atrial fibrillation (5R01HL143010-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10240320. Licensed CC0.

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